Method of performing diagnosis or treatment erendoscopically and medical treatment device

ABSTRACT

A method of performing diagnosis or treatment perendoscopically in which a guide catheter is inserted inside a body, and the guide catheter is made to protrude beyond a distal end portion of the endoscope; and in which a first diagnosis or treatment is performed by inserting a medical treatment device that performs the diagnosis or treatment of the body inside the guide catheter, and causing this medical treatment device to protrude by a first predetermined distance from the guide catheter; and in which the medical treatment device is extracted from the guide catheter; and in which a second diagnosis or treatment is performed by inserting a medical treatment device into the guide catheter, and causing the medical treatment device to protrude by a second distance which is adjusted in accordance with the first predetermined distance.

TECHNICAL FIELD

The present invention relates to a method of performing diagnosis ortreatment perendoscopically, and to a medical treatment device that isused when a body is being diagnosed or treated.

BACKGROUND ART

When diagnosis or treatment of a peripheral bronchial tube of abronchial tube is being performed, treatment is often performed byinserting an endoscope through a natural orifice of a body. At thistime, it is necessary to insert a medical treatment device through atreatment channel of the endoscope, and guide the medical treatmentdevice to a desired position of the complexly branching peripheralbronchial tube. Accordingly, firstly, an inductor is inserted underX-ray radioscopy as far as the vicinity of a lesion portion. Theinductor has a bendable working portion provided at a distal endthereof. Once the working portion of the inductor has reached abranching point of the peripheral bronchial tube, the working portion isbent towards the peripheral bronchial tube which is the object of thediagnosis or treatment, and the inductor is subsequently pushed forward(see, for example, Patent document 1). After this, the inductor is usedas a guide and the guide catheter is inserted as far as the vicinity ofthe object member. The inductor is then extracted from the endoscope.When, for example, tissue of a lesion portion is to be sampled, biopsyforceps are inserted through the guide catheter as far as the vicinityof the object portion.

[Patent document 1] Japanese Patent Application, First Publication No.2004-154485

DISCLOSURE OF INVENTION Problems to be Solved by the Invention

However, in the process to perform a diagnosis or treatment, when theinductor and the other medical treatment devices used for the diagnosisor treatment are being switched, it is difficult to keep the workingportion at the distal end of each medical treatment device constantly ina desired position, and a skilled hand is required. Each time a medicaldevice is inserted, it is necessary to confirm the position of theworking portion by X-ray radioscopy, and each time the medical device isinserted into a biological subject, the position thereof needs to beadjusted. Because of this, workability is poor.

The present invention was conceived in consideration of the abovedescribed circumstances and it is an object thereof to enable positionadjustment of the distal end working portion to be carried out easilyand accurately when the medical treatment device is inserted or removeda plurality of times in the biological subject.

Means for Solving the Problem

The present invention is a method of performing diagnosis or treatmentperendoscopically that includes: a step in which a guide catheter isinserted inside a body following an endoscope that has been insertedinto the body, and the guide catheter is made to protrude beyond adistal end portion of the endoscope; a step in which a first diagnosisor treatment is performed by inserting a medical treatment device thatperforms the diagnosis or treatment of the body inside the guidecatheter, and causing this medical treatment device to protrude by afirst predetermined distance from the guide catheter; a step in whichthe medical treatment device is extracted from the guide catheter; and astep in which a second diagnosis or treatment is performed by insertinga medical treatment device into the guide catheter, and causing themedical treatment device to protrude by a second distance which isadjusted in accordance with the first predetermined distance.

When diagnosis or treatment is performed a plurality of times, a medicaltreatment device is used in which the amount that it protrudes from aguide catheter is adjusted in advance. Even when the medical treatmentdevice is switched, because each medical treatment device protrudes fromthe guide catheter by a distance that corresponds to that medicaltreatment device, the diagnosis or treatment is performed quickly andreliably. Here, the first predetermined distance and the secondpredetermined distance may be the same distance. In addition, the numberof times that diagnosis or treatment is performed by means of a medicaltreatment device is not limited to two times.

In the present invention, it is also possible for the step in which thefirst diagnosis or treatment is performed and the step in which thesecond diagnosis or treatment is performed to be performed usingdifferent medical treatment devices. In this case, the diagnosis ortreatment which is performed on the first occasion is different fromthat performed on the second occasion.

The present invention is a medical treatment device that includes: aninsertion portion that is capable of being inserted into an internalhole in a guide catheter that is inserted into a body, and at whosedistal end is provided a working portion that performs diagnosis ortreatment of the body; and a position adjustment component that iscapable of moving from a position where it has been fitted onto an outercircumference of the guide catheter to a position where an amount thatthe insertion portion is inserted relative to the guide catheter is apredetermined amount.

When diagnosis or treatment is performed using this medical treatmentdevice, as a result of the medical treatment device protruding by apredetermined distance from the guide catheter, the position adjustmentcomponent is slid and the guide catheter and the medical treatmentdevice are engaged together via the position adjustment component.

The present invention is a medical treatment device that includes: aninsertion portion that is capable of being inserted into an internalhole in a guide catheter that is inserted into a body, and at whosedistal end is provided a working portion that performs diagnosis ortreatment of the body; and a position adjustment component that isfitted onto the insertion portion so as to be capable of moving in thelongitudinal direction of the insertion portion, and is fixed to theinsertion portion at a position determined by an operator before theinsertion portion is inserted into the guide catheter, and is formed soas to be able to press against the guide catheter.

When diagnosis or treatment is performed using this medical treatmentdevice, the guide catheter is inserted after the position of theposition adjustment component has been adjusted in advance to a positionsuitable for the diagnosis or treatment. When the position adjustmentcomponent comes up against the guide catheter, the distal end portion ofthe medical treatment device protrudes by a predetermined length fromthe guide catheter. Because the position of the position adjustmentcomponent does not change even when the medical treatment device isextracted from the guide catheter, even if a medical treatment device isonce again inserted into the guide catheter, there is no change in theamount of protrusion of the distal end portion of the medical treatmentdevice.

Effects of the Invention

According to the present invention, when a plurality of diagnoses ortreatments are made of a lesion portion, because the distal end portionof a medical treatment device protrudes from a guide catheter by alength that has been adjusted in advance, positioning of the medicaltreatment device can be reliably carried out. Because the positioningadjustment that needs to be made each time a medical treatment device isreplaced can be carried out easily, the time required for an operationcan be reduced. Moreover, the effects from the x-ray radiation can bereduced.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a diagram showing the structure of an endoscope that is usedin an embodiment of the present invention.

FIG. 2 is a diagram showing the structure of a curette which is anexample of an inductor serving as a medical treatment device.

FIG. 3 is a diagram showing a guide catheter.

FIG. 4 is a diagram showing the structure of a medical treatment devicesystem when the medical treatment device is an ultrasonic probe.

FIG. 5 is a diagram showing the structure of a medical treatment devicesystem when the medical treatment device is a biopsy forceps.

FIG. 6 is a diagram showing the structure of a medical treatment devicesystem when the medical treatment device is a cytological diagnosisbrush.

FIG. 7 is a diagram showing in typical form a bronchial tube serving asan example of a treatment object.

FIG. 8 is a diagram showing an endoscope inserted in a bronchial tubewith the distal end portion thereof in contact with and fixed in thebronchial tube.

FIG. 9 is a diagram showing a curette inserted as far as a lesionportion.

FIG. 10 is a diagram showing a curette used as a guide with the guidecatheter inserted as far as a lesion portion.

FIG. 11 is a diagram showing a curette being extracted while the guidecatheter is left in place.

FIG. 12 is a diagram showing an ultrasonic probe inserted through aguide catheter to a lesion portion.

FIG. 13 is a diagram showing a placement of a position adjustmentcomponent in the case of FIG. 12.

FIG. 14 is a diagram when a distal end position of a guide catheter isaccurately set.

FIG. 15 is a diagram showing a biopsy forceps inserted through a guidecatheter to a lesion portion.

FIG. 16 is a diagram used to illustrate a task when an amount ofprotrusion of an operating portion is adjusted by the positionadjustment component.

FIG. 17 is a diagram showing the position adjustment component beingslid towards a base end side.

FIG. 18 is a diagram showing the position adjustment component which hasbeen slid to the base end side being pressed against the guide cathetercausing the operating portion to protrude considerably.

FIG. 19 is a diagram showing the endoscope in the bronchial tube fixedin position by a balloon provided in the endoscope.

FIG. 20 is a diagram illustrating the task of fixing the endoscope usingan anchoring component that is provided in an endoscope insertionportion.

FIG. 21 is a diagram showing an endoscope fixed that is fixed by ananchoring component and by the friction force of a mouthpiece.

FIG. 22 is a diagram showing a guide catheter fixed to the endoscope bya clip.

FIG. 23 is a diagram illustrating another embodiment of the positionadjustment component.

FIG. 24 is a diagram showing state in which a guide catheter and amedical treatment device are anchored via a position adjustmentcomponent.

FIG. 25 is a diagram showing a position adjustment component being slidfrom a guide catheter side to a medical treatment device side.

FIG. 26 is a diagram illustrating another embodiment of the positionadjustment component.

FIG. 27 is a cross-sectional view of FIG. 26.

DESCRIPTION OF THE REFERENCE NUMERALS 1 Endoscope

10 Curette (Medical treatment device)12, 33 Insertion portion

17, 35 Catheter

20 Guide catheter30, 50, 60 Medical treatment device system31 Ultrasonic probe (Medical treatment device)40, 82, 90 Position adjustment component51 Biopsy forceps (Medical treatment device)61 Cytological diagnosis brush (Medical treatment device)

BEST MODE FOR CARRYING OUT THE INVENTION

Embodiments of the present invention will now be described in detailwith reference made to the drawings.

FIRST EMBODIMENT

An endoscope that is used in the present embodiment is shown in FIG. 1.An endoscope 1 has an endoscope operating unit 2 that is operated by anoperator, and a flexible endoscope insertion portion 3 that is insertedinto a body extends from the endoscope operating unit 2. An angle knob 4that bends a distal end portion of the endoscope portion 3, a switch 5and the like are provided on the endoscope operating unit 2. Inaddition, a control unit, a display unit, and the like (not shown) areconnected by a universal cable 6. An insertion aperture 7 is formed in aside portion of the endoscope operating unit 2. The insertion aperture 7is an aperture on the extracorporeal side of a working channel 9. Aforceps plug 8 is fitted into the insertion aperture 7. The workingchannel 9 passes through the interior of the endoscope insertion portion3 and opens at the distal end thereof. Medical treatment devices, guidecatheters (described below) and the like are inserted through thisworking channel 9.

A curette which is a medical treatment device used for cell abrasion andhas a cup and a bending mechanism at its distal end is an example of amedical treatment device. As is shown in FIG. 2, in a curette 10, anelongated, flexible insertion portion 12 extends from the operating unit11 which is operated by the operator. A working portion 13 is providedat the distal end of the insertion portion 12. The operating unit 11 hasan operating unit main body 14, and a slider 15 is mounted on theoperating unit main body 14 such that it can move forward and rearwarddirections. A ring for manipulation is provided on a base end side ofthe operating unit main body 14. The slider 15 is able to move forwardand rearward directions in the longitudinal direction of the operatingunit main body 14, namely, in the longitudinal direction of theinsertion portion 12. An end portion of an operating wire 16 is fixed tothe slider 15. The operating wire 16 is inserted into a catheter 17 ofthe insertion portion 12 such that it can move forward and rearwarddirections.

The insertion portion 12 has a structure that enables the operating wire16 to be inserted through the catheter 17. The catheter 17 ismanufactured from a flexible, elongated material. A distal end portionof the operating wire 16 is drawn into the working portion 13. Theworking portion 13 has a structure in which three arm portions 13 a, 13b, and 13 c are joined together by pins in this order from the insertionportion 12 side. The arm portion 13 a on the distal end side is formedas a cup that is used when abraded tissue is being sampled. Theoperating wire 16 passes through the interior of these arm portions 13a, 13 b, and 13 c. The operating wire 16 is fixed to the arm portion 13c that is located on the furthest distal end side. Accordingly, when theoperating wire 16 is pulled, the working portion 13 is able to bendaround the fulcrums formed by the respective pins. Furthermore, when theoperating wire 16 is restored, the bent working portion 13 can beextended substantially in a straight line. Note that the working portion13 may also be formed by a single body that has deformable thinportions.

This curette 10 is used by being inserted through a guide catheter 20such as that shown in FIG. 3. The guide catheter 20 has a flexible tube21, and a base end portion 22 thereof has an outer circumference whosediameter has been enlarged. The inner diameter of the tube 21 is largeenough to allow the insertion portion 12 of the curette 10 to beinserted therein such that it can move forward and rearward directions.The outer diameter of the tube 21 is less than the diameter of theworking channel 9. The outer diameter of the base end portion 22 islarger than the diameter of the working channel 9. The length of theguide catheter 20 is longer than that of the working channel 9. Notethat the base end portion 22 is fixed to the tube 21, however, it mayalso be formed as a single unit with the tube 21.

Various medical treatment device systems are shown in FIG. 4 throughFIG. 6.

A medical treatment device 30 shown in FIG. 4 has a guide catheter 20,and an ultrasonic probe 31 that is used by being inserted in the guidecatheter 20. The ultrasonic probe 31 is a medical treatment device thathas a connector portion 32, an elongated, flexible insertion portion 33that extends from the connector portion 32, and a working portion 34that is provided at the distal end of the insertion portion 33. Theconnector portion 33 is mechanically and electrically connected to adrive apparatus (not shown). In the insertion portion 33, a flexibleshaft 36 is rotatively inserted through the interior of the catheter 35.The flexible shaft 36 is inserted inside a cover 37 of the workingportion 34. An ultrasonic transducer 38 is mounted onto a distal endportion of the flexible shaft 36 inside the cover 37. The ultrasonictransducer 38 is an element that emits ultrasonic waves after receivingsignal transmissions from a cable (not shown) that passes through theinterior of the flexible shaft 36, and receives ultrasonic waves thathave returned after striking an object and converts these ultrasonicwaves into electrical signals. The interior of the cover 37 is filledwith an ultrasonic wave medium such that ultrasonic waves can be easilytransmitted.

The catheter 35 of the insertion portion 33 has an outer diameter thatenables it to be inserted into an internal hole in the guide catheter20. A position adjustment component 40 is slidably fitted onto an outercircumference of a base end portion side of the catheter 35. Theposition adjustment component 40 is a ring-shaped component having ahole through which the catheter 35 passes, and the outer diameterthereof is larger than that of the base end portion 22 of the guidecatheter 20. The position adjustment component 40 is manufactured from aresin which is able to expand and contract. This position adjustmentcomponent 40 is able to be moved manually by the operator in thelongitudinal direction of the catheter 35. The position adjustmentcomponent 40 remains in position when the operator stops manually movingthe position adjustment component 40. The position where the positionadjustment component 40 is installed is adjusted to a position where,when the ultrasonic probe 31 has been inserted through the guidecatheter 20, the working portion 34 protrudes from the distal endportion of the guide catheter 20 by a first predetermined distance. Theposition adjustment component 40 does not move during the process inwhich the ultrasonic probe 31 is inserted in the guide catheter 20, orin the process in which it is removed from the guide catheter 20, andhas sufficient engaging force with the catheter 35 to allow it to remainin its adjusted position.

A medical treatment device 50 shown in FIG. 5 has a guide catheter 20,and a biopsy forceps 51 that is used by being inserted into the guidecatheter 20. The biopsy forceps 51 is a medical treatment device thathas an operating unit 11, an elongated, flexible insertion portion 12that extends from the operating unit 11, and a treatment portion (i.e.,a working portion) 52 that is provided at the distal end of theinsertion portion 12. The insertion portion 12 is constructed with theoperating wire 16 passing through the interior of the catheter 17. Theoperating wire 16 joins together the slider 15 of the operating unit 11and a pair of biopsy cups 53 of the treatment portion 52. In thetreatment portion 52, the pair of biopsy cups 53 are mounted on asupporting component 54 such that they can open and close freely. Eachbiopsy cup 53 is joined to the operating wire 16 via a linking mechanism(not shown). When the operating wire 53 is moved forward, the pair ofbiopsy cups 53 are opened, while when the operating wire 53 is movedbackward, the pair of biopsy cups 53 are closed.

The catheter 17 of the insertion portion 12 has an outer diameter thatenables it to be inserted into the internal hole in the guide catheter20. A position adjustment component 40 is slidably fitted onto an outercircumference of a base end portion side of the catheter 17. Theposition where the position adjustment component 40 is installed isadjusted to a position where, when the biopsy forceps 51 has beeninserted through the guide catheter 20, the treatment portion 52protrudes from the distal end portion of the guide catheter 20 by asecond predetermined distance. The second distance may be the same as ormay be different from the first distance.

A medical treatment device 60 shown in FIG. 6 has a guide catheter 20,and a cytological diagnosis brush 61 that is used by being inserted intothe guide catheter 20. The cytological diagnosis brush 61 is a medicaltreatment device that has an operating unit 62, an elongated, flexibleinsertion portion 12 that extends from the operating unit 62, and atreatment portion (i.e., a working portion) 63 that is provided at thedistal end portion of the insertion portion. In the insertion portion12, the operating wire 16 passes through the interior of the catheter17. The operating wire 16 penetrates an operating unit main body 65 ofthe operating unit 62 such that it can move forward and rearwarddirections, and a manipulation ring 64 is fixed to an end portion of theoperating wire 16 that extends from the operating unit main body 65. Abrush 66 is attached to a distal end portion of the operating wire 16.The brush 66 is able to be housed inside the catheter 17 of theinsertion portion 12. When the brush 66 is housed inside the insertionportion 12, a distal end tip 67 thereof strikes against the distal endof the insertion portion 12.

The catheter 17 of the insertion portion 12 has an outer diameter thatenables it to be inserted into the internal hole in the guide catheter20. A position adjustment component 40 is fitted onto an outercircumference of a base end portion side of the catheter 17. Theposition where the position adjustment component 40 is installed isadjusted to a position where, when the cytological diagnosis brush 61has been inserted through the guide catheter 20, the distal end portionof the treatment portion 63 or the insertion portion 12 protrudes fromthe distal end portion of the guide catheter 20 by a third predetermineddistance. The third distance may be the same as the first distance andthe third distance or may be different therefrom.

Note that in the biopsy forceps 51 and the cytological diagnosis brush61 as well, the position adjustment component 40 does not move duringthe process in which the biopsy forceps 51 and the cytological diagnosisbrush 61 are inserted into the guide catheter 20, or in the process inwhich they are removed from the guide catheter 20, and has sufficientengaging force with the catheter 17 to allow it to remain in itsadjusted position.

Next, an operation of the present embodiment will be described. Notethat in the description given below, as is shown in FIG. 7, an exampleis described of a case in which diagnosis and treatment are performed onlesion portions W3 (i.e., subject portions) occurring in a peripheralbronchial tube W2 of a bronchial tube W1 of a human body.

As is shown in FIG. 8, the endoscope 1 is inserted into a bronchial tubeW1. The endoscope 1 is inserted through a natural orifice of a patient,namely, through either the mouth or nose. Because the bronchial tube W1becomes narrower as it moves inwards, the insertion of the endoscope 1is stopped when the distal end portion of the endoscope insertionportion 3 comes up against an inner wall of the bronchial tube W1. Atthis time, the endoscope insertion portion 3 is fixed by friction to thebronchial tube W1.

Once the endoscope 1 has been fixed in position relative to thebronchial tube W1, the operator inserts the curette 10 into the workingchannel 9. The curette 10 is used as an inductor to guide the guidecatheter 22 the lesion portions W3. Accordingly, the insertion portion12 is inserted in advance into the guide catheter 20 before the curette10 is inserted into the endoscope 1. This causes the curette 10 toprotrude from the distal end of the endoscope 1 while irradiating x-rayson to the bronchial tube W1 and verifying an image of the area aroundthe lesion portions W3. At a branch portion W11 of the peripheralbronchial tube W2, the slider 15 of the operating unit 11 shown in FIG.2 is pulled so that the operating wire 16 is drawn back towards theoperator, thereby bending the working portion 13. After the distal endportion of the bent working portion 13 has been positioned so as to facetowards the peripheral bronchial tube W2 where the lesion portions W3are located, the entire curette 10 is moved forward. As a result, thecurette 10 is inserted into the peripheral airway to W2 where the lesionportions W3 are located.

As is shown in FIG. 9, when the working portion 13 of the curette 10reaches the lesion portions W3, the guide catheter 20 is pushed therein.Alternatively, if the guide catheter 20 is moved forward together withthe curette 10, then it is not necessary to perform the pushing inoperation. As is shown in FIG. 10, the guide catheter 20 is pushed inuntil the distal end portion thereof reaches the vicinity of the lesionportions W3. The position of the distal end of the guide catheter 20 isconfirmed through observation under x-ray irradiation. Thereafter, as isshown in FIG. 11, the curette 10 is removed by itself from inside thebody while the guide catheter 20 is left in position.

Next, as is shown in FIG. 12, the ultrasonic probe 31 is insertedthrough the guide catheter 20, and is inserted into the peripheralbronchial tube W2. The ultrasonic probe 31 is used as a medicaltreatment device that provides an image of the lesion portions W3. As isshown in FIG. 13, because the position adjustment component 40 is fittedin a pre-adjusted position on the insertion portion 33 of the ultrasonicprobe 31, the ultrasonic probe 31 can be inserted until the positionadjustment component 40 strikes against the base end portion 22 of theguide catheter 20. At this time, as is shown in FIG. 12, the workingportion 34 at the distal end protrudes by the first distance from theguide catheter 20, and is placed in a position which correspondssubstantially to the center in the longitudinal direction of the lesionportions W3. A drive apparatus is installed in the connector portion 32of the ultrasonic probe 31, and ultrasonic waves are irradiatedoutwardly in a radial direction while the ultrasonic transducer 38 isbeing rotated around its axis by means of the flexible shaft 36. Whenultrasonic waves reflected by the peripheral bronchial tube W2 arereceived by the ultrasonic transducer 38, an extraction image of thelesion portions W3 is obtained. By using the ultrasonic probe 31, it ispossible to confirm the precise positions and state of the lesionportions W3. For example, by employing x-ray irradiation, informationconcerning the depth direction, and information concerning positionalrelationships between the lesion portions W3 and blood vessels which aredifficult to obtain can be obtained.

Positioning of the distal end of the guide catheter 20 is then carriedout accurately while the operator confirms the provided image of thelesion portions W3. For example, the operator confirms the preciseposition of the lesion portions W3 by moving the ultrasonic probe 31forwards and backwards in the longitudinal direction of the peripheralbronchial tube W2, and matches the position of the distal end portion ofthe guide catheter 20 to a position on the outer edge of the lesionportions W3. Once the positioning of the guide catheter 20 has ended,the guide catheter 20 is fixed relative to the endoscope 1. Frictionfixing by means of the forceps plug 8 shown in FIG. 13 can be used inorder to fix the guide catheter 20 in position. Once the guide catheter20 is fixed, the ultrasonic probe 31 is withdrawn by itself. As is shownin FIG. 14, the guide catheter 20 is left behind in a state of beingpositioned in the vicinity of the lesion portions W3.

Thereafter, as is shown in FIG. 15, a medical treatment device in theform of the biopsy forceps 51 is inserted into the peripheral bronchialtube W2 through the guide catheter 20. Because the position adjustmentcomponent 40 is fitted onto a previously adjusted position on theinsertion portion 12 of the biopsy forceps 51, if the biopsy forceps 51is inserted until the position adjustment component 40 strikes againstthe base end portion 22 of the guide catheter 20, then the distal endtreatment portion 52 protrudes by the pre-adjusted second distance fromthe guide catheter 20. This second distance is a position suitable forsampling the lesion portions W3, and a biopsy is performed at thisposition. If the slider 15 of the operating unit 11 is then movedforward, the operating wire 16 is pushed in and the pair of biopsy cups53 are opened. If the slider is then pulled back after the biopsy cups53 have been pressed against a lesion portion W3, the pair of biopsycups 53 are closed around the tissue of the lesion portion W3. If theentire biopsy forceps 51 is then pulled back, the tissue inside thebiopsy cups 53 is torn away. If the biopsy forceps 51 is then extractedfrom the endoscope 1, the tissue of the lesion portion W3 can besampled. Note that because the guide catheter 20 is fixed relative tothe endoscope 1, there is no change in the insertion position of theguide catheter 20.

When the tissues of the lesion portions W3 are to be sampled a pluralityof times, the biopsy forceps 51 is again inserted into the endoscope 1.If the operator has not consciously moved the position adjustmentcomponent 40 and places the position adjustment component 40 up againstthe guide catheter 20, the biopsy is performed in substantially the sameposition. If a plurality of biopsies are to be performed at differentpositions in the longitudinal direction of the peripheral bronchial tubeW2, a fine adjustment is made by moving the position adjustmentcomponent 40 manually in the longitudinal direction of the insertionportion. By moving the position adjustment component 40 backwardstowards the base end side, a biopsy can be performed on tissue at adeeper position (i.e., a position further away from the endoscope 1). Ifthe position adjustment component 40 is pushed out to the distal endside, then a biopsy can be performed on tissue at a shallower position(i.e., a position closer to the endoscope 1). If a plurality of biopsiesare to be performed, then it is possible to either use the same biopsyforceps 51, or use different biopsy forceps 51 in sequence.

When the cytological diagnosis brush 61 shown in FIG. 6 is to be used,the cytological diagnosis brush 61 is inserted until the pre-adjustedposition adjustment component 40 comes up against the base end portion22 of the guide catheter 20. The distal end treatment portion 63protrudes by the pre-adjusted third distance from the distal end portionof the guide catheter 20. This third distance is a position suitable forsampling the lesion portions W3, and a biopsy is performed at thisposition. If the manipulation ring 64 of the operating unit 62 is movedforwards relative to the operating unit main body 64, then the brush 66protrudes from the insertion portion 12. After the brush 66 has scrapeda lesion portion W3 and tissue has been sampled, then the cytologicaldiagnosis brush 61 is extracted by itself from the endoscope 1 and theguide catheter 20 is left behind.

When cells are to be sampled a plurality of times using the cytologicaldiagnosis brush 61, in the same way as in the case of the biopsy forceps51, the cytological diagnosis brush 61 is inserted in or removed fromthe guide catheter 20. As long as the position of the positionadjustment component 40 is not moved intentionally, the insertionposition of the cytological diagnosis brush 61 remains constant.

Here, the procedure when the position of the position adjustmentcomponent 40 is adjusted will be described with reference made to FIG.16 through FIG. 18. Firstly, as is shown in FIG. 16, when the positionadjustment component 40 comes up against the guide catheter 20, thedistal end portion of the cytological diagnosis brush 61, which includesthe treatment portion 63, protrudes by a predetermined distance from thedistal end portion of the guide catheter 20. If the operator desires tomake the treatment portion 63 protrude even further, as is shown in FIG.17, the position adjustment component 40 is made to slide to the baseend side by itself while the positions of the insertion portion 12 andthe guide catheter 20 remain fixed. Once the position adjustmentcomponent 40 has been slid for the desired distance, it is stopped. Asis shown in FIG. 18, if the cytological diagnosis brush 61 is pushedinto the guide catheter 20, then the position adjustment component 40which has completed its slide movement can be inserted until it strikesagainst the base end portion 22 of the guide catheter 20. The treatmentportion 63 at this time protrudes further by the same distance that theposition adjustment component 40 has been moved. This operation can beperformed in reverse if a reduction of the protrusion amount of thetreatment portion 63 is required.

According to this embodiment, by causing the guide catheter 20 toprotrude from the endoscope 1 and inserting it as far as the vicinity ofa lesion portion W3, it is possible to reliably introduce a medicaltreatment device even when a diagnosis or treatment is to be performedin a narrow lumen such as the peripheral bronchial tube W2 in a portionwhere the endoscope 1 cannot reach. In particular, when diagnosis ortreatment is to be performed in which a medical treatment device isinserted and extracted a number of times, the medical treatment devicecan be inserted quickly into the vicinity of a lesion portion W3.

When the position adjustment component 40 is fitted onto a medicaltreatment device, and the position adjustment component 40 is placed ata position that is suitable for this medical treatment device, then itis possible to place the working portion in a predetermined positionsimply by placing the position adjustment component 40 against the guidecatheter 20. Because the position adjustment component 40 does not movewhen the medical treatment device is extracted, the time taken up bymanual operations can be shortened. When different type of medicaltreatment devices are to be used, by adjusting the position adjustmentcomponent in advance to a position that is suitable for the medicaltreatment device, it is possible to shorten the time required for manualoperations. This adjustment may be performed in advance, oralternatively, it is also possible when the curette 10 is being insertedto confirm the position of the curette 10 and, based on this, to thenfinely adjust the position adjustment component 40.

Here, a variant example of a method for fixing the endoscope 1 relativeto the bronchial tube W1 is shown in FIG. 19 through FIG. 21. As isshown in FIG. 19, it is also possible to fit a balloon 70 onto an outercircumference of the distal end of the endoscope insertion portion 3. Iffluid is supplied to the balloon 70 from outside the body through acatheter tube (not shown), the balloon 70 becomes inflated and touchesthe inner wall of the bronchial tube W1. As a result, the endoscope 1 isfixed by friction in the bronchial tube W1.

As is shown in FIG. 20, it is also possible to fit an endoscope engagingcomponent 71 on the endoscope insertion portion 3. The endoscopeengaging component 71 is formed by an elastic tube or the like, and isfixed by friction to an inner wall of a mouthpiece 72 which is fittedinside the patients mouth.

Moreover, the method used to fix the guide catheter 20 relative to theendoscope 1 is not limited to using the forceps plug 8, and it is alsopossible for it to be fixed by hand. Furthermore, a clip 75 such as thatshown in FIG. 22 may also be used as a fixing component. Once the guidecatheter 20 has been inserted a predetermined length into the workingchannel 9, an end portion 75 a of the clip 75 is held so as to open up agripping portion 76 which is then pressed against the boundary betweenthe tube 21 of the guide catheter 20 and the forceps plug 8. If theoperator then removes his hand from the end portion 75 a of the clip 75,the clip 75 is closed by the urging force of the elastic component 77,and the guide catheter 20 and forceps plug 8 become gripped. As aresult, the guide catheter 20 is positioned relative to the endoscope 1and is fixed via the clip 75.

SECOND EMBODIMENT

A second embodiment of the present invention will now be described withreference made to the drawings.

The structure of a medical treatment device system is shown in FIG. 23.A medical treatment device system 80 has a guide catheter 81, and thecytological diagnosis brush 61 which is used by being inserted in theguide catheter 81. The medical treatment device is not limited to thecytological diagnosis brush 61, and may also be the ultrasonic probe 31,or the biopsy forceps 51 or the like.

In the guide catheter 81, a position adjustment component 82 is fittedby press insertion or the like onto a base end portion of the tube 21.The position adjustment component 82 does not need to be fixed relativeto the tube 21, and it is also possible for it to be able to slide inthe longitudinal direction of the tube 21. Note that when it is removedfrom the tube 21, the inner diameter of the position adjustmentcomponent 82 is smaller than the outer diameter of the catheter 17 ofthe insertion portion 12 of the cytological diagnosis brush 61.

In this medical treatment device system 80, in the state shown in FIG.23, the cytological diagnosis brush 61 is able to move forwards orbackwards freely relative to the guide catheter 81. As is shown in FIG.24, if the position adjustment component 82 is moved backwards so that aportion of the position adjustment component 82 is pushed out from thebase end portion of the guide catheter 81, the portion that has beenpushed out of the position adjustment component 82 is pressed againstthe outer circumference of the catheter 17 of the insertion portion 12of the cytological diagnosis brush 61. As a result, the cytologicaldiagnosis brush 61 is fixed on the guide catheter 81 via the positionadjustment component 82. When the cytological diagnosis brush 61 isbeing inserted through the guide catheter 81, once the treatment portion63 of the cytological diagnosis brush 61 is protruding from the guidecatheter 81 by a predetermined amount needed for the treatment, theposition adjustment component 82 is moved so that the cytologicaldiagnosis brush 61 is fixed to the guide catheter 81. When the medicaltreatment device system 80 is being inserted into the working channel 9of the endoscope 1, it is possible to guide the treatment portion 63 toa lesion portion W3 while the aforementioned predetermined amount iskept unchanged.

Moreover, as is shown in FIG. 25, it is also possible to move the entireposition adjustment component 82 from the tube 82 of the guide catheter81 completely onto the insertion portion l2 of the cytological diagnosisbrush 61. The position adjustment component 82 is engaged at apre-adjusted position. When the cytological diagnosis brush 61 isinserted into the guide catheter 81, and the position adjustmentcomponent 82 is placed against the base end portion of the guidecatheter 81, the treatment portion 63 can be made to protrude by apredetermined distance from the distal end of the guide catheter 81.

THIRD EMBODIMENT

A position adjustment component according to the present embodiment isshown in FIG. 26 and FIG. 27. The position adjustment component 90 has acylindrical outer component 91 and a cylindrical inner component 92through which the catheter 17 of a medical treatment device is able tobe inserted. A ring-shaped groove 91 a through which a distal endportion 92 a of the inner component 92 is able to be inserted is formedin an inner circumference of a base end portion of the outer component91. A receiving portion for an elastic ring 93 is formed in a distal endportion of this groove 91 a.

When the elastic ring 93 is housed in this receiving portion, an innerdiameter thereof is substantially equivalent to the outer diameter ofthe catheter 17 when no external force is acting thereon. When thedistal end portion of the inner component 92 is inserted into the groove91 a of the outer component 91 and is pressed in tightly, the elasticring 93 becomes squashed and presses against the catheter 17. As aresult, the position adjustment component 90 becomes fixed in positionon the catheter 17. If a structure is employed in which a state in whichthe distal end portion 92 a of the inner component 92 and the groove 91a of the outer component 91 are mutually engaged or fastened together byscrews can be maintained, then a state in which the position adjustmentcomponent 90 is fixed in position on the catheter 17 can be maintainedeven when the operator removes his hand. By using this type of medicaltreatment device, the same operation and effects as in the firstembodiment can be obtained.

Note that the present invention is not limited to the above describedrespective embodiments, and the present invention may be put towidespread use insofar as these do not depart from the spirit or scopeof the present invention.

For example, the object of diagnosis or treatment is not limited to thebronchial tube W1, and maybe another lumen.

The medical treatment device system may also be constructed to includethe curette 10 and catheter 20, and also the position adjustmentcomponent 40 or the position adjustment component 82. In addition, asthe medical treatment device it is also possible to use a medicaltreatment laser probe or high-frequency forceps.

The positions where the position adjustment components 40 and 82 areused may be the positions to which they were adjusted during shipping,or may be adjusted by the operator.

Instead of being manufactured from cylindrical components, the positionadjustment components may also be constructed so as to be fixed inposition as a result of a predetermined position of the catheter of theinsertion portion being gripped by a clip or the like.

INDUSTRIAL APPLICABILITY

The present invention can be applied to devices that are inserted into abody to perform diagnosis or treatment, and to systems that includethese devices.

1. A method of performing diagnosis or treatment perendoscopicallycomprising: a step in which a guide catheter is inserted inside a bodyfollowing an endoscope that has been inserted into the body, and theguide catheter is made to protrude beyond a distal end portion of theendoscope; a step in which a first diagnosis or treatment is performedby inserting a medical treatment device that performs the diagnosis ortreatment of the body inside the guide catheter, and causing thismedical treatment device to protrude by a first predetermined distancefrom the guide catheter; a step in which the medical treatment device isextracted from the guide catheter; and a step in which a seconddiagnosis or treatment is performed by inserting a medical treatmentdevice into the guide catheter, and causing the medical treatment deviceto protrude by a second distance which is adjusted in accordance withthe first predetermined distance.
 2. The method of performing diagnosisor treatment perendoscopically according to claim 1, wherein the step inwhich the first diagnosis or treatment is performed and the step inwhich the second diagnosis or treatment is performed are performed usingdifferent medical treatment devices.
 3. A medical treatment devicecomprising: an insertion portion that is capable of being inserted intoan internal hole in a guide catheter that is inserted into a body, andat whose distal end is provided a working portion that performsdiagnosis or treatment of the body; and a position adjustment componentthat is capable of moving from a position where it has been fitted ontoan outer circumference of the guide catheter to a position where anamount that the insertion portion is inserted relative to the guidecatheter is a predetermined amount.
 4. A medical treatment devicecomprising: an insertion portion that is capable of being inserted intoan internal hole in a guide catheter that is inserted into a body, andat whose distal end is provided a working portion that performsdiagnosis or treatment of the body; and a position adjustment componentthat is fitted onto the insertion portion so as to be capable of movingin the longitudinal direction of the insertion portion, and is fixed tothe insertion portion at a position determined by an operator before theinsertion portion is inserted into the guide catheter, and is formed soas to be able to press against the guide catheter.